It has been a busy 2017 at the Center for Senior Services (CSS), and we are pleased to report on our advocacy efforts. Throughout the year we have been advocating on a wide range of senior issues relating to health care (Medicare and Medicaid), Social Security and affordable housing. Our work included meetings on Capitol Hill, organizing tours of B’nai B’rith sponsored buildings and co-sponsoring rallies on affordable housing. During the year we were excited that our work was noted by the Jewish Telegraph Agency (JTA), The Times of Israel and the New York Jewish Week.

Our advocacy efforts went into high gear in March when the White House’s proposed 2018 “skinny” budget was released, which called for a 13 percent reduction in the Department of Housing and Urban Development’s budget. A few months later when the administration’s more detailed budget was announced, B’nai B’rith was severely disappointed that Section 202, which is housing that was developed for low-income seniors, was underfunded and the White House proposed a rental increase for residents. 

Staying on top of the issue, the CSS team started visiting senator and representative’s offices on Capitol Hill that represent B’nai B’rith sponsored buildings. Specifically, we met with offices that work on the House and Senate Appropriations Subcommittees on Transportation, Housing and Urban Development. These committees are responsible for writing legislation that funds rental subsidies for the Section 202 program.  During the course of these meeting we explained to staff members how damaging the White House’s budget would be for low-income Section 202 residents. While the 2018 budget has not been finalized we are hopeful that our advocacy efforts on Capitol Hill will lead to the Section 202 program being funded more. 

In addition, we followed up those visits by inviting members of Congress and their staff to tour B’nai B’rith Section 202 buildings throughout the country. We are pleased to report that Reps. Jamie Raskin (D-Md.), Matt Cartwright (D-Pa.), Grace Meng (D-N.Y.) and Charlie Dent (R-Pa.), representing both political parties, toured our sponsored properties.  Furthermore, three of the four members who visited B’nai B’rith sponsored buildings work on the Appropriations Committees. These tours were a fantastic opportunity for members of Congress to see the benefits of the Section 202 program, and gave residents a chance to speak with their elected representative. Residents were able to directly tell their member of Congress the vital role Section 202 housing plays in their lives.

B’nai B’rith was also pleased to co-host with LeadingAge the “Save HUD 202” Rally and partner with the National Low Income Housing Coalition for the “National Housing Day of Action” over the summer. These rallies took place on Capitol Hill and featured representatives and senators who spoke about the need for affordable housing. We were certainly delighted  members of Congress who represent B’nai B’rith sponsored buildings attended the event. 

Our advocacy during the course of the year didn’t just stop with affordable housing. We spoke out against the White House and Congress’ attempts to repeal and replace the Affordable Care Act (ACA). After analyzing various proposed bills, B’nai B’rith was very concerned how these policies could negatively impact seniors. For example, many of the proposed replacement bills would have cut critical funding to Medicaid, allowed older Americans to be charged more for insurance, repealed vital taxes that help fund Medicare and waive important regulations that protect health care consumers. We spoke out on these issues by releasing press releases, blogs and joined with liked minded organizations opposing this legislation in a full page advertisement in Politico.   

Recently, B’nai B’rith has been very vocal against the recently passed tax reform legislation. We expressed serious reservations about this bill because of the damaging impact it could have on funding for Medicare and Medicaid attributable to rising deficits that will give cover to members of Congress to slash spending. In addition, the negative consequences repealing the ACA’s individual mandate will have on older Americans. We brought our concerns straight to congressional offices during our regular scheduled Capitol Hill visits regarding Section 202. However, we certainly applaud Congress for not eliminating the Low Income Housing Tax Credit which is critical for affordable housing construction, and the medical expense deduction which is incredibly important to countless seniors with high health care costs.
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The CSS team embarks on 2018 looking to continue our success from 2017. We will certainly look to invite more members of Congress and their staff to B’nai B’rith sponsored buildings, and advocate for the Section 202 program and other policies that are vital to seniors. 

By Breana Clark

Achieving greater recognition of the needs of our homeless population has become an undeterred focus of mine. Professionally, I am connected to the residents who call B’nai B’rith sponsored, low-income senior housing home, and through volunteering with a local United Methodist Church, I help address local homelessness in the District of Columbia. Through these organizations, I have witnessed a devastating national trend: the apparent aging of our nation’s homeless population.
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On the surface, the current proportion of homeless individuals who are seniors represents a failure of our society to take care of our oldest citizens. Though, it is also an expensive problem to ignore. An older person who has not yet reached “retirement age” (those ages 50-64) represents a group which frequently falls between safety nets that are age based. Programs that are meant to intercept the part of our population that, generally speaking, are cycling off the workforce are generally reserved for those who have reached the magical age of 65 (or 62 for subsidized senior housing). Thus, many folks who have lost jobs, lost income or who do not have enough savings, find themselves stuck between the gap, and enter their “senior years” having expensive untreated conditions and deteriorating health.

It should come at no surprise that navigating the conditions of living on the street or experiencing insecure housing (this includes nighttime shelters, a couch at a friend or relative’s home, or frequent relocation because of unreliable conditions) exacerbates physical and/or mental health conditions, poor nutrition and untreated chronic illness. It’s imperative to point this out, as we see that health care needs by those aged 50-64 who lack housing are awfully similar to housed individuals 65 and older. Premature aging and shortened life expectancies are inevitable when one lacks the basic of human necessities in order to survive.

Simply put, seniors have the steepest housing challenge. This should come at no surprise if we look at increasing poverty amongst retirees as well as the decreasing availability of affordable housing. In fact, more than four million people above the age of 65 live in poverty, according to the U.S. Department of Health and Human Services. Of those individuals, only 1.6 million receive rental subsidies from the United States Department of Housing and Urban Development (HUD).

About 10,000 people turn 65 every day in U.S. Based on demographics alone, Justice in Aging, a national nonprofit legal advocacy organization that fights senior poverty, estimates that this will result in nearly 93,000 homeless seniors, doubling the 44,000 in 2010. This number becomes even more significant when economic factors are taken into consideration. While many may hold a stereotyped version of who is included among our homeless and home insecure, it’s important to remember a myriad of economic occurrences that have proven to be especially burdensome in the last decade: the Great Recession, mortgage debt accumulation following the housing crisis, wage stagnation, skyrocketing underemployment, the rising cost of medication and goods and the increasing lack of affordable housing.

Furthermore, in light of recent natural disasters having required evacuation, hunkering down and taking shelter, we have witnessed how quickly circumstances can change for someone depending on their very meager earnings or assets to survive. The recent tragedy of several seniors dying at a Florida nursing home that found itself in the wake of Hurricane Irma illustrates a true reminder that we need to be able to provide safe, quality care and housing for seniors regardless of whether they can live independently or not. ​

In my capacity as a volunteer, with a mission to serve our homeless in Washington, D.C., I’ve learned a lot about the unique needs of those in our community who lack housing. What has become obvious is the need to address the significant number of folks who have reached their older years but lack housing, health care and an income that can support their basic needs. We are living in a time where our lack of commitment to seniors’ well being, as they age, is not just appalling; the circumstances are dire. Every day, seniors die from a lack of resources in a country that saw economic, social and political progress as a result of their contributions.

If Congress and the current administration want a society that is great, it has to start simple: we must prioritize health and housing for ourselves and our neighbors as we age. We must strive for a society that does not allow housing insecurity and plummeting health to be inevitable part of aging into poverty. We must commit to taking care of the oldest among us.

The Senate Aging Committee recently held a two part series of hearings highlighting the issue of social isolation experienced by many people as they age. It was made apparent that there are serious physical health consequences to prolonged isolation—some experts say its equivalent to smoking fifteen cigarettes a day. The reality is this growing epidemic of isolation will only increase in the coming years as the number of older adults continues to surge. Considering all the technological, infrastructural, social and cultural responses required to properly address this need, I’m left dwelling on the role young people, and particularly millennials like myself, can have preventing the social isolation of our older neighbors.
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We know that a whole range of societal changes contribute to isolation in aging. Changes in our birth rates, family structures and our proximity to relatives are all shifts that have been well documented. Additionally, there are common occurrences late in life that can create isolating circumstances: a late career job change, retiring, moving into different housing or a change in cultural surroundings. But, I think there is much more to this. As a result of the pervasive ageism in America, isolation as one ages is exacerbated. Throughout our society, we either stereotype older people or exclude them from critical planning efforts—or both. By excluding, whether purposefully or inadvertently, the contributions and perspectives of older adults from spaces where major decisions are made, we create a society where it is increasingly more difficult for them to thrive.

Our communities, whether rural or urban, should be safe and age-friendly from walkability to bus routes to housing design. Our workplaces should allow people to work as long as they are able to perform the duties of their job and recognize that older adults have a lot to offer, especially to young people who are newer to the workforce. Housing should be both affordable and available to everyone, and especially those that reach retirement age. We should design and build housing that will work for any resident, whether they are old, young or disabled. Technology should be accessible to those who did not learn how to operate personal devices at a very young age.

However, in order for these things to exist in our society, we must address the underlying causes of systemic ageism. Without doing so, we will continue to exclude a great portion of our population. We, inevitably, will continue to tell our future, older selves, “At some point, your opinion and needs are no longer important to greater society.” We must recognize that the risk factors of isolation are only more pronounced as a person ages because of their inability to have a “seat at the table.” In every industry, and particularly in technology, it is imperative that we stop expecting older people to create their own solutions without ever giving them the tools to do so.

Millennials have a unique role in addressing the ageism that has fostered a culture of leaving seniors out of the equation. Now the largest generation in the workforce, millennials are represented in every industry. Instead of being yet another generation that expects older people to adapt and integrate themselves in a society built around the young and able-bodied, what if we strived for deliberate inclusion? And, what does taking responsibility look like?
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First, the thoughts, solutions and perspectives of those experiencing isolation should be at the forefront of every initiative around social isolation and age-friendly communities. This can look as simple as reconciling the gap in communication used by different generations. It may also involve urban planning that includes realistic walk times at intersections, or smart phones that do not operate on intuition that only a young app developer may possess. Including all people in our society is not just an idealistic, fuzzy feeling, it’s good for business! Imagine having a community where transportation was not a barrier to carrying out daily errands, or relying on technology to purchase home goods was not a frustrating, humiliating experience.

What if, from the beginning, we were cognizant of the difficulties that can result from a society increasing its dependency upon technological advances? What if—by simply asking—we were to realize that seniors are more than capable of providing solutions to the barriers one experiences as they age?

Until we make the conscious, purposeful decision that older members of our community not only should, but have to be a part of planning the society we want to live in, we will find ourselves trying to fix the mistakes we’ve made or, worse, assume that the opinions and lives of seniors are not important. We must be aware that the built environment and social environment are interdependent. The culture shift necessary for such consideration would require the empathy to understand that most all of us, if we are so lucky, will experience the changes presented through aging. When we talk about the “special needs of seniors,” we should remember that these are considerations that we all deserve throughout our lifetime.

As a young, able-bodied person, accessibility and inclusion should be tenets I lift up out of empathy for others and, at the very least, out of self-interest! I know that a society in which there are barriers to participation and socialization for some of us will, inevitably, hurt us all.

(Photo via Flickr)

I’m sure you are beginning to become familiar with the ways in which HUD assistance houses over 10 million individuals. This, of course, is carried out via public housing (rental housing for over 1 million low-income families, the elderly, and those with disabilities), multifamily subsidized housing (which includes Section 202 Supportive Housing for the Elderly, the Congregate Housing Services Program, and Section 811 Supportive Housing for Persons with Disabilities Program) and housing vouchers (Section 8 project-based or tenant-based rent vouchers for low-income individuals, families, the elderly and the disabled). In addition, properties are often financed or assisted financially through the FHA insurance loan programs and low-income housing tax credits.

Five HUD programs provide affordable rental housing that is designated for low-income senior households. Section 202 provides housing exclusively for older adults and people with disabilities, while four other HUD programs provide housing for all age groups but have devoted the property to housing senior residents. These include Section 236 and Section 221 (d)(3) programs, public housing and project-based Section 8 programs dedicated primarily for use by senior households. After the Section 202 program, project-based Section 8 housing provides the most housing dedicated specifically to elderly households.

As you become more familiar with how HUD works to combat poverty for individuals and families all over our country using a modest portion of the federal budget, I want to bring your attention to the estimated 2 million seniors, most often low-income single women in their mid-70s to early-80s, who are housed through HUD subsidies or call HUD-assisted facilities home. HUD, a department that long ago began prioritizing the well-being of our most vulnerable seniors, has wavered in recent years on its commitment to take care of the oldest among our nation’s poor. I have the privilege of working directly with residents and staff of our 38 low-income supportive senior housing facilities, housing about 8,000 seniors across the country. Working with these buildings has transformed my understanding of what HUD-supportive housing is, and of who lives there. One thing has become particularly clear: We must include seniors in all of our conversations about publicly-funded housing.

I was disappointed that your remarks to the Senate Banking, Housing, & Urban Affairs Committee did not include comments about affordable housing for seniors. However, I was pleased to read you indicated in your written responses to Sen. Sherrod Brown that the Section 202 program is “an important tool” for senior housing and that you will lobby President Trump for the inclusion of this vital program as part of a comprehensive infrastructure package. Across the spectrum of publicly-assisted housing, seniors are everywhere. Not only are they served by senior-specific programs, but they are a significant part of the population in every other category of HUD’s portfolio. Frankly, I am worried that within your focus on eliminating “government dependence,” you do not account that many people who benefit from HUD are retirees and disabled people whose incomes will never really improve, and whose need for housing assistance cannot be dismissed. Many of your statements spoke to the desire to get people off of public assistance and to move them towards gainful employment through a “development of innate talent” and “work requirements.” While economic success and independence are laudable goals to facilitate for the working poor, they are not realistic for fixed income older adults.  

Many seniors living now in HUD assisted housing—who are in your terms “dependent” on it—have worked their entire lives and are still only able to afford housing by combining meager Social Security benefits with assistance from your department. While many of these individuals live in senior-specific facilities, about a third of households that make up public housing are senior-led homes or include a family member who is a senior. I believe it is important to remember that work should not be the sole focus when we discuss assisting those experiencing poverty. If we forget about the special needs required by millions of seniors who are now unable to work, we have committed a great injustice. I, and many senior housing advocates, believe the focus should instead be placed upon addressing the root causes of the shortage in affordable housing. We believe that accessing affordable housing is prevented by systematic issues including, but not limited to, predatory mortgage lending, a stagnant and unrepresentative COLA used for Social Security and astronomical price surges in many areas where seniors hoped to “age in place” due to gentrifying neighborhoods.

I am encouraged to know that you will be able to apply a health perspective on housing, because good health outcomes are incompatible with unstable or inappropriate housing. Further, housing can be a platform for prevention and early health intervention services. I look forward to the integration of your medical knowledge into your approach to HUD programs and hope that you will ensure “aging in place” and preventative care are tenets of your leading this department. Research tells us that ensuring the well-being of an aging person while they are healthy or maintaining a chronic condition prevents hundreds of thousands of dollars being spent at the end of that individual’s life. We know that these end-of-life prices surges can occur through Medicaid funded nursing home care or through receiving emergency medical services. We also know that this can be prevented when folks are able to “age in place” with comfort and dignity. More so, those in the supportive housing industry know that co-location of services and housing is crucial to maintaining one’s health as they age. Affordable, supportive housing not only allows people access to “healthy” aging, but helps people avoid injuries and unnecessary nursing home placements.

I think it’s only fair that a society be judged on the way it takes care of its oldest members. While we experience a growing population of seniors who are currently 75 years of age and older, the senior population, those aged 65 and over, is projected to double by the year 2030, from 35 million to 71.5 million. In 2010, more than 44,000 people aged 65 and over were homeless. In many ways, I am saddened our country has not done a better job of creating and preserving housing for older adults. However, I hope that I can appeal to you, as a man of faith, that we lift up and support our older neighbors who face significant financial barriers, and deserve a warm place to call home!
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While I hope you will take my concerns to heart, I would love nothing more than for you to visit any of the 38 senior housing facilities my organization, B’nai B’rith International, sponsors across the United States from Maryland to California. We hope that a visit from you to any of our thriving communities would serve as a fact-gathering mission and support the good work that you will be leading!
 
Sincerely,
Breana Clark, MSW

You only have days left to determine whether you want to change or enroll in a Medicare Part D plan. In fact, there are only five days left. With less than a week, why would I bother talking about this on such short notice? While many have pointed to premium increases in 2017, an average of 4 percent according to Avalere, I caution you to look a little closer! By digging deeper, your wallet may be thanking you this time next year. 
 
For 2017 plans, the benefit of paying less for a monthly premium may not outweigh the annual cost of medications you depend upon. I urge you to take the time to visit Medicare online and learn more before you choose. If you stick with me, I’ll go into how you can access the Medicare Plan Finder on the Medicare.gov website. But, before I can do that, I want to explain the reason behind my concern.  If you had planned to default to your 2016 plan under the assumption a small change in your premium would be the only adjustment you’d make, you may be very disappointed.
 
Year-to-year costs of popular drugs are seeing major increases for the upcoming year, and Part D plans have changed the structure of their drug pricing in response. If you aren’t careful about picking a plan, or if you have added any medications this year, you could see jaw-dropping increases. For example, a co-pay for one single drug went from $7 to $350.
 
Several trends among insurers have made surprising shifts in cost sharing for beneficiaries possible. Some of the reasons you may be seeing this is because of:

• Tier shifting:  more and more sophisticated drugs, for which there is no generic, and shifting of generic drugs from lower, less expensive tiers to higher, more costly tiers.
• Plans are charging coinsurance: a percentage of the full cost of a drug instead of set co-pays which are flat rates like $20, $45, or $60 dollars for any drug on a specific tier.
• Pressure on Medicare to keep premiums down.

Now, I hope I haven’t lost you. For those of you who are reluctant to use your computer or device, I encourage you to utilize these steps (or, bribe one of your children or grandchildren to help out, the holidays ARE coming up). Sometimes the internet is there to help us out and, in this case, save you a whole lot of money.
 
Instructions for using the Medicare Plan Finder
 
Before starting, make a list of drugs you take. Then, access the Medicare Plan Finder by ​clicking here.
 
You’ll see prompts like the ones listed below:

• Step 1: Enter Your Information
  You can perform either a general or personalized search with your own information. A personalized search will allow you to enter your zip code, Medicare number, last name, and date of birth, while a general search will only require a zip code for plans offered in your area. You will also be able to enter whether you have a Medigap policy (aka Medicare Supplemental Insurance) or if you receive any help from Medicaid or SSI (which might make you eligible for extra discounts in Part D).
  
  
• Step 2: Enter Your Drugs
  Enter the list of drugs you have written down. You will be prompted to select the dosage, quantity, frequency, and whether you get your medicine from a retail or mail order pharmacy. Before entering, you will have the ability to select a lower cost generic for the drug if it is available.
  
  
• Step 3: Select Your Pharmacies
  You can select up to two.
  
  
• Step 4: Refine Your Plan Results
  You will be made aware of how many plans are available to you in your area, based upon the information entered. These plans can be narrowed down, dependent upon the type of coverage you need and the types of factors you’re looking for.
  
  

Once presented with the different plans, select each you’re interested in and compare. You can select up to three at a time. You want to make sure the results are sorted by lowest estimated annual retail drug cost. This will ensure the first plans you see offered have the lowest annual out-of-pocket expense, rather than just low premiums or low deductibles.  You need to know what your total spending for the year would be under each plan.
 
Additionally, on each of the plans, you will see “Lower Your Drug Costs.” Once selected, you will have an opportunity to select cheaper versions of the drugs you originally input based upon their projected annual cost.  (Only do this for drugs where you know you could take either.)
 
When comparing plans, you want to focus on the heading “Estimate of What YOU Will Pay for Drug Plan Premium and Drug Costs.” This amount is what should be used to compare to what you spent last year, and what you’re budgeting for this coming year.
 
When I performed this exercise, I entered medications for a variety of needs such as: lowering cholesterol and high blood pressure, treating Type II Diabetes, as well as an anti-depressant—all fairly common prescription medications. In each case, when comparing plans in my area, the cheapest premium did not correlate to the least amount paid for annual out-of-pocket. In fact, in nearly every comparison, the most expensive premium often was paired with an annual out-of-pocket expense several hundred dollars less than other plans with cheaper premiums.
 
More than ever, this year, it does not make sense to stay with the same plan as you selected last year without comparing.  And the best news is: it’s not too late! Enrollment is still open through Wednesday, Dec. 7, 2016.  
 
AARP Medicare Resource Guide: Understanding Your Prescription Drug Coverage